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Näppä, Ulla
Publications (6 of 6) Show all publications
Näppä, U., Lindqvist, O., Rasmussen, B. H. & Axelsson, B. (2016). Routine assessment of performance status during palliative chemotherapy when approaching end-of-life. European Journal of Oncology Nursing, 21, 266-271
Open this publication in new window or tab >>Routine assessment of performance status during palliative chemotherapy when approaching end-of-life
2016 (English)In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 21, p. 266-271Article in journal (Refereed) Published
Abstract [en]

Purpose Palliative chemotherapy treatment (PCT) offered late in the cancer disease trajectory may be problematic. It is not easy to accurately calculate whether the potential benefits will outweigh the side-effects. This study investigates whether routine use of the Performance Status in Palliative Chemotherapy questionnaire (PSPC) affects the proportions of patients receiving PCT during the last month of life, care utilization, and documentation routines. A secondary aim was to gather registered nurses' experiences of the PSPC in routine use. Methods Eighty incurable patients with cancer who had used the PSPC before PCT were compared to 160 matched controls, using non-parametric tests. Nurses' reflections on the PSPC were collected and reviewed. Results No significant differences were found between users and non-users of the PSPC in terms of proportions receiving PCT during the last month of life. Higher proportions of patients older than 74 years received PCT than in previous studies (40% versus 17%). Nurses considered the questionnaires to be a valuable complement to verbal information when trying to acquire an accurate picture of patients' performance status. Conclusion At this point in the development of the PSPC we did not find any significant decreases in the proportion of patients receiving PCT during the last month in life. However, as the nurses valued the PSPC, it can be used as a complementary tool in assessment of performance status until further research is conducted.

Keywords
Cancer, Case-control study, Chemotherapy, Decision-making, Palliative care, Questionnaire, Rural hospitals
National Category
Health Sciences
Identifiers
urn:nbn:se:miun:diva-29701 (URN)10.1016/j.ejon.2015.11.001 (DOI)
Available from: 2016-12-21 Created: 2016-12-21 Last updated: 2018-01-10Bibliographically approved
Näppä, U., Lundgren, A.-B. & Axelsson, B. (2016). The effect of bereavement groups on grief, anxiety, and depression - A controlled, prospective intervention study. BMC Palliative Care, 15(1), Article ID 58.
Open this publication in new window or tab >>The effect of bereavement groups on grief, anxiety, and depression - A controlled, prospective intervention study
2016 (English)In: BMC Palliative Care, ISSN 1472-684X, E-ISSN 1472-684X, Vol. 15, no 1, article id 58Article in journal (Refereed) Published
Abstract [en]

Abstact: Background: Bereavement groups are believed to be beneficial as preventive interventions to reduce the development of complicated grief for people at risk after the death of a significant other. This study aimed to investigate whether measurable effects on grief, anxiety, and depression could be detected in those participating in bereavement groups compared to non-participating controls. Methods: Questionnaires covering the Texas Revised Inventory of Grief (TRIG), the Hospital Anxiety and Depression Scale (HADS), and background questions were handed out pre-intervention, five weeks and one year post-intervention to bereaved caregivers invited to bereavement groups. The results were analysed with non-parametric methods. Results: A total of 124 individuals answered the questionnaires, and were divided into three categories: participants, non-participants unable to participate, and non-participants not wanting to participate in bereavement groups. At the one-year follow up, participants and those unable to participate reported higher levels of grief and were more anxious than those not wanting to participate. Depression did not differ between the groups. Conclusions: Participation in bereavement groups did not produce any effects on grief, anxiety, or depression in comparison to non-participants who were unable to participate. Non-participants who did not want to participate reported lower levels of grief and anxiety than the other two groups.

Keywords
Bereavement, Cancer, Family caregivers, Oncology, Palliative care, Support
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-28934 (URN)10.1186/s12904-016-0129-0 (DOI)000379857000001 ()27405317 (PubMedID)2-s2.0-84978715167 (Scopus ID)
Note

Article

Available from: 2016-09-27 Created: 2016-09-27 Last updated: 2017-11-21Bibliographically approved
Näppä, U., Rasmussen, B. H., Axelsson, B. & Lindqvist, O. (2014). Challenging situations when administering palliative chemotherapy: A nursing perspective. European Journal of Oncology Nursing (21), 266-271
Open this publication in new window or tab >>Challenging situations when administering palliative chemotherapy: A nursing perspective
2014 (English)In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, no 21, p. 266-271Article in journal (Refereed) Published
Abstract [en]

Palliative chemotherapy treatments (PCT) are becoming more common for patients with incurable cancer; a basic challenge is to optimize tumour response while minimizing side-effects and harm. As registered nurses most often administer PCT, they are most likely to be confronted with difficult situations during PCT administration. This study explores challenging situations experienced by nurses when administering PCT to patients with incurable cancer.

Methods

Registered nurses experienced in administering PCT were asked in interviews to recall PCT situations they found challenging. Inspired by the narrative tradition, stories were elicited and analysed using a structural and thematic narrative analysis.

Results

A total of twenty-eight stories were narrated by seventeen nurses. Twenty of these were dilemmas that could be sorted into three storylines containing one to three dilemmatic situations each. The six dilemmatic situations broadly related to three interwoven areas: the uncertainty of the outcome when giving potent drugs to vulnerable patients; the difficulty of resisting giving PCT to patients who want it; and insufficient communication between nurses and physician.

Conclusion

Nurses who administer PCT are engaged in a complex task that can give rise to a number of dilemmatic situations. The findings may be interpreted as meaning that at least some situations might be preventable if the knowledge and insight of all team members – nurses, physicians, patients, and relatives – are jointly communicated and taken into account when deciding whether or not to give PCT. Forming palliative care teams early in the PCT trajectory, could be beneficial for staff and patients.

National Category
Other Medical Sciences
Identifiers
urn:nbn:se:miun:diva-30585 (URN)10.1016/j.ejon.2014.06.008 (DOI)
Available from: 2017-04-10 Created: 2017-04-10 Last updated: 2017-05-08Bibliographically approved
Näppä, U. (2014). Dilemmas in palliative chemotherapy when approaching end-of-life. (Doctoral dissertation). Umeå: Print & Media, Umeå universitet
Open this publication in new window or tab >>Dilemmas in palliative chemotherapy when approaching end-of-life
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background When cure is no longer possible, medical care should aim for a transition to palliative care regardless of disease. Patients with incurable cancer are often treated with palliative chemotherapy (PCT), starting with the intent to prolong life and increase quality of life. Eventually, in the late stages of the disease, the patient reaches a transition phase when further PCT neither prolongs life nor adds any predominantly positive effects.

Aim of the thesis

Study I: To analyse the proportion of patients with incurable cancer who received palliative chemotherapy during the last month of life, and to identify their discriminative characteristics.

Study II: To develop a questionnaire assessing performance status in palliative chemotherapy, and to test its psychometric properties.

Study III: To explore challenging situations experienced by registered nurses when administering palliative chemotherapy to patients with incurable cancer.

Study IV:  To investigate whether routine use of the Performance Status in Palliative Chemotherapy (PSPC) questionnaire in PCT would affect the proportion of patients receiving PCT during the last month of life, hospital admissions, notifications of performance status, documented decisions of ceasing PCT in the medical records, and/or place of death. A secondary aim was to gather registered nurses’ experiences of PSPC in clinical use.

Methods In Studies I and IV, information from the medical records of deceased patients with epithelial cancers was used in descriptive analyses of the proportions of patients receiving PCT in counties in northernmost Sweden. A quantitative design was chosen, using non-parametric statistical methods. In Study II, a brief patient-completed questionnaire assessing performance status was developed and psychometrically tested. In Study III, data from research interviews with registered nurses were analysed qualitatively with a narrative thematic approach.

Results Studies I and IV showed that about 25% of patients receiving PCT were treated during the last month of life. This group of patients had more hospital admissions, were less likely to die at home, and had fewer instances of documentation of the decision to cease PCT. The questionnaire developed in Study II was shown to have acceptable psychometric qualities such as reliability, validity, and sensitivity to detect deterioration in performance status. Study IV showed that the questionnaire gave nurses valuable information about patients’ performance status. The results also showed that 97% of nurses and 48% of physicians documented their patients’ performance status in the medical records. Study III demonstrated that when nurses administered PCT they considered futile, they could experience dilemmas created by the unforeseeable outcomes of PCT or stemming from insufficient communication between nurses, patients, next-of-kin, and physicians.

Conclusions Administration of PCT can create dilemmatic situations for both the patient and medical staff when approaching end-of-life. This is underlined by the finding that some 25% of treated patients received their last round of PCT as late as during the last month of life. The decisions to cease PCT were less likely to be documented for patients who had received PCT within a month before death. Nurses described situations where they felt they were in the middle of the decision-making process regarding whether or not to continue PCT. They found the treatments were given on the authority of someone else; the physician’s recommendation or the patient’s and/or relatives’ request.

The unpredictability of PCT was a continuous theme in the work described in this thesis, emphasizing the necessity of individually assessing every patient before PCT in order to minimize the risk of futile treatments. The attempt to develop a reliable and valid questionnaire for systematic assessment of performance status has increased future possibilities to monitor this parameter in PCT when approaching end-of-life. The questionnaire developed as part of this thesis has provided nurses with increased knowledge of patients’ performance status. If routinely used, it may help decrease the proportion of patients receiving PCT during the last month of life, though this remains to be rigorously proven. Further research efforts are needed to progress in the task of optimizing rather than maximizing the use of PCT when approaching end-of-life.

Place, publisher, year, edition, pages
Umeå: Print & Media, Umeå universitet, 2014. p. 62
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1660
Keywords
cancer, chemotherapy, decision-making, dilemma, palliative care, performance status, questionnaire, registered nurse
National Category
Other Medical Sciences
Identifiers
urn:nbn:se:miun:diva-30586 (URN)978-91-7601-037-2 (ISBN)
Public defence
2014-05-16, Hörsalen Snäckan, Östersunds sjukhus, Östersunds sjukhus, Östersund, 08:48 (Swedish)
Opponent
Supervisors
Funder
Swedish Cancer Society, CAN2009/761
Available from: 2017-04-12 Created: 2017-04-10 Last updated: 2017-04-12Bibliographically approved
Näppä, U., Lindqvist, O. & Axelsson, B. (2012). Avoiding harmful palliative chemotherapy treatment in the end of life: Development of a brief patient-completed questionnaire for routine assessment of performance status. The journal of supportive oncology, 10(6), 230-237
Open this publication in new window or tab >>Avoiding harmful palliative chemotherapy treatment in the end of life: Development of a brief patient-completed questionnaire for routine assessment of performance status
2012 (English)In: The journal of supportive oncology, Vol. 10, no 6, p. 230-237Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Earlier studies have shown that up to 43% of patients with incurable cancer are treated with palliative chemotherapy in the last month of their lives. Although pretreatment blood tests are acceptable, the patient's general condition may not permit further palliative chemotherapy treatment (PCT). Presently, there is no patient self-assessment tool available to monitor performance status during PCT.

OBJECTIVES: To describe the development process of the Performance Status in Palliative Chemotherapy (PSPC) questionnaire, and the testing of its psychometric properties.

METHODS: The questionnaire was developed by the authors based on the Eastern Cooperative Oncology Group Performance Status Rating (ECOG PSR) scale as well as their clinical experience with PCT. Adult patients who were diagnosed with epithelial cancers (n = 118) were enrolled to test the PSPC questionnaire for reliability, sensitivity for change, and validity.

RESULTS: After stepwise modifications of the PSPC questionnaire, psychometric tests revealed acceptable values for reliability (via a test-retest method), sensitivity for change (via a comparison of patients with progressive disease over time), and validity (via a comparison of the PSPC vs the Edmonton Symptom Assessment System [ESAS]).

LIMITATIONS: At this stage of questionnaire development, we are unable to conclude whether the PSPC is superior to the conventional ECOG PSR in the evaluation of performance status and the prediction of chemotherapy response.

CONCLUSION: Psychometric tests suggest that the PSPC questionnaire may be a useful patient-completed tool in the late stages of cancer disease to routinely monitor performance status in palliative chemotherapy treatments so as to minimize the risk of inflicting more harm than good.

National Category
Other Medical Sciences
Identifiers
urn:nbn:se:miun:diva-30584 (URN)
Available from: 2017-04-10 Created: 2017-04-10 Last updated: 2017-09-11Bibliographically approved
Näppä, U., Lindqvist, O., Rasmussen, B. & Axelsson, B. (2011). Palliative chemotherapy during the last month of life. Annals of Oncology, 22(11), 2375-2380
Open this publication in new window or tab >>Palliative chemotherapy during the last month of life
2011 (English)In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 22, no 11, p. 2375-2380Article in journal (Refereed) Published
Abstract [en]

Background: This study analyses the potential discriminative characteristics for patients with incurable cancer who received palliative chemotherapy during their last month of life.

Patients and methods: The study includes all patients with epithelial cancer treated with palliative chemotherapy who died in 2008 in northern Sweden. Demographic parameters and care utilization data were registered. Data were analyzed using nonparametric methods.

Results: Of 374 included patients, 87 (23%) received chemotherapy during the last month of life. These patients had a significantly shorter survival time from first palliative treatment to death, were admitted more frequently to hospital, more often lacked a documented decision to cease treatment, and died less frequently at home.

Conclusions: The results indicate covariations between palliative chemotherapy treatments in the last month of life and unfavorable patient outcomes. As almost one of four patients with incurable cancer received their last round of palliative chemotherapy <31 days before death, there is a potential for improved routines.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:miun:diva-30583 (URN)10.1093/annonc/mdq778 (DOI)
Available from: 2017-04-10 Created: 2017-04-10 Last updated: 2017-11-29Bibliographically approved
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